Form 14 Authorization for Release of Information

Form 14 is a U.S. Department of the Treasury - Bureau of the Fiscal Service form also known as the "Authorization For Release Of Information". The latest edition of the form was released in February 1, 2016 and is available for digital filing.

Download an up-to-date fillable Form 14 in PDF-format down below or look it up on the U.S. Department of the Treasury - Bureau of the Fiscal Service Forms website.

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Department of the Treasury
RESET
Bureau of the Fiscal Service
Authorization for Release of
Information
Fax completed form to: (314) 418-4121
Centralized Receivables Service (CRS)
1. TO: U.S. Department of the Treasury, Bureau of the Fiscal Service (Fiscal Service)
FROM:
Name (include alias and maiden names):
Mailing Address (include street address, P.O. box, suite no., city, state, zip code):
Social Security Number or Employer Identification Number:
Telephone No.:
Fax No.
2. I authorize Fiscal Service, its employees, agents, and contractors, to disclose to the following person:
REPRESENTATIVE:
Name (include alias and maiden names):
Mailing Address (include street address, P.O. box, suite no., city, state, zip code):
Company Name (optional):
Telephone No.:
Fax No.
any and all information related to a receivable owed by me to the United States Government.
3. Fiscal Service, its employees, agents, and contractors, are not required to inform me of disclosures made under
this authorization.
4. This authorization will be valid for 6 months from the date of signing, unless sooner revoked by me in writing
and the revocation is received and processed by Fiscal Service at this address: CRS Servicing, P.O. Box
970014, St. Louis, MO 63197.
5. A photocopy or facsimile copy of this signed authorization has the same force and effect as an original.
The person named in paragraph 1 must sign below. If signed by a corporate officer, partner, guardian, executor,
receiver, administrator, trustee, or party other than the individual obligor, I certify that I have the authority to
execute this form. A separate Fiscal Sserice Form 14 must be provided for each obligor.
Signature of Person Authorizing Disclosure
Date
Print Name of Person Authorizing Disclosure
Print Title of Person Authorizing Disclosure
Privacy Act Statement: Collection of this information is authorized by 5 U.S.C. §§ 552a and 7701(c). This information will be used to identify your
receivables owed to Federal agencies that use CRS services. This information will be disclosed to persons as authorized by you. Additional disclosures of
this information may be to Federal agencies collecting your debt or issuing payments to you. The purpose of the additional disclosures will be to verify the
accuracy of the information provided and to assist with proper application of payments to balances due, and pursuit of collection of any amounts remaining
unpaid. Where the taxpayer identification number is your Social Security Number, collection of this information is required by 31 U.S.C. §
7701(c). If you fail to furnish the information requested on this form, including your Social Security Number, Fiscal Service will not disclose to
third parties information concerning receivables owed by you and being collected through CRS.
FS Form 14 (2-16)
DEPARTMENT OF THE TREASURY
BUREAU OF THE FISCAL SERVICE
Department of the Treasury
RESET
Bureau of the Fiscal Service
Authorization for Release of
Information
Fax completed form to: (314) 418-4121
Centralized Receivables Service (CRS)
1. TO: U.S. Department of the Treasury, Bureau of the Fiscal Service (Fiscal Service)
FROM:
Name (include alias and maiden names):
Mailing Address (include street address, P.O. box, suite no., city, state, zip code):
Social Security Number or Employer Identification Number:
Telephone No.:
Fax No.
2. I authorize Fiscal Service, its employees, agents, and contractors, to disclose to the following person:
REPRESENTATIVE:
Name (include alias and maiden names):
Mailing Address (include street address, P.O. box, suite no., city, state, zip code):
Company Name (optional):
Telephone No.:
Fax No.
any and all information related to a receivable owed by me to the United States Government.
3. Fiscal Service, its employees, agents, and contractors, are not required to inform me of disclosures made under
this authorization.
4. This authorization will be valid for 6 months from the date of signing, unless sooner revoked by me in writing
and the revocation is received and processed by Fiscal Service at this address: CRS Servicing, P.O. Box
970014, St. Louis, MO 63197.
5. A photocopy or facsimile copy of this signed authorization has the same force and effect as an original.
The person named in paragraph 1 must sign below. If signed by a corporate officer, partner, guardian, executor,
receiver, administrator, trustee, or party other than the individual obligor, I certify that I have the authority to
execute this form. A separate Fiscal Sserice Form 14 must be provided for each obligor.
Signature of Person Authorizing Disclosure
Date
Print Name of Person Authorizing Disclosure
Print Title of Person Authorizing Disclosure
Privacy Act Statement: Collection of this information is authorized by 5 U.S.C. §§ 552a and 7701(c). This information will be used to identify your
receivables owed to Federal agencies that use CRS services. This information will be disclosed to persons as authorized by you. Additional disclosures of
this information may be to Federal agencies collecting your debt or issuing payments to you. The purpose of the additional disclosures will be to verify the
accuracy of the information provided and to assist with proper application of payments to balances due, and pursuit of collection of any amounts remaining
unpaid. Where the taxpayer identification number is your Social Security Number, collection of this information is required by 31 U.S.C. §
7701(c). If you fail to furnish the information requested on this form, including your Social Security Number, Fiscal Service will not disclose to
third parties information concerning receivables owed by you and being collected through CRS.
FS Form 14 (2-16)
DEPARTMENT OF THE TREASURY
BUREAU OF THE FISCAL SERVICE

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